Clinical study on the therapeutic effects and mechanism of progesterone in the treatment ofr acute severe head injury

Objective To evaluate the therapeutic effects of Progesterone （PG） on the patients with acute severe traumatic brain injury, and investigate its neuroprotective mechanisms. Methods Fifth-six patients with acute severe traumatic head injury were divided randomly into two groups： 26 cases were treated with PG and 30 cases were control. Neurological outcome of the patients were assessed using Glasgow Coma Scale （GCS）, Glasgow Outcome Scale （GOS）, verbal and motor functions scale and Karnofsky Performance Scale （KPS）.     

弥漫性脑肿胀去骨瓣减压手术的疗效评价

Objective　To evaluate the therapeutic effect of decompressive craniectomies in acute traumatic patients with diffuse brain swelling. Methods　23 patients with acute posttraumatic diffuse brain swelling admitted and confirmed by X-CT were randomly treated by surgical decompressive craniectomies (operative group). Their treated results were compared with those of another 11 patients treated conservatively (non-operative group) at the same period. Results　The mortality rate was similar in both operative and nonoperative groups. Conclusion　The decompressive craniectomy operation has no value and not valid for treatment of acute posttraumatic diffuse brain swelling.     

Craniocerebral trauma

Clinical analysis of factors affection the prognosis of acute craniocerebral injury： 866 cases report;Prediction of the outcome of 639 cases survived from severe brain injury;The management of skull base fracture with rhinorrhagia;The differential proteomic studies of hippocampus following traumatic brain injury in rats with mild hypothermia;Screening of serum biomarkers and establishment of diagnostic fingerprint in early severe traumatic brain injury patients     

Clinical Observation on Effect of Xuesaitong Injection (血塞通注射液) as Auxiliary Treatment of Severe Craniocerebral Injury

Objective To evaluate the effect of Xuesai-tong injection (XSTI, 血塞通注射液 , a preparation of Panax Notoginseng) as auxilliary treatment of severe craniocerebral injury. Methods Eighty-seven patients with severe craniocerebral injury were selected and randomly divided into the treated group (n=44) and the control group (n = 43), they were treated with conventional treatment, and XSTI was given additionally to the treated group. Intracranial pressure (ICP) and Glasgow coma score (GCS) of all patients were measuredafter 1 or 2-week treatment, and Glasgow outcome scale (GOS) of them was determined 3 months later. Then the therapeutic effect in the two groups were compared. Results After treatment, the ICP was lower, GCS higher and GOS better in the treated group than those in the control group significantly, all showing statistical significance (P<0.05). Conclusion XSTI has marked clinical therapeutic effect in treating patients with severe craniocerebral injury.Original article on CJITWM (Chin) 2004 ;2     

Cerebral venous malformation

Objective To improve the diagnostic and therapeutic level of the cerebral venous malformation (CVM). Methods The clinical procedure, Therapy, and outcome of 34 patients with cerebral venous malformation were summarized. Results According to GOS, 24 patients got good recovery, 8 moderately disabled and 2 died. Conclusion Most of patients with CVM could be treated conservatively, but for those patient with progressive neurological deficits,surgical therapy should be taken into accounts. 10 refs,6 figs.     

Clinical characteristics, diagnosis and management of respiratory distress syndrome in full-term neonates

Background Respiratory distress syndrome （RDS） is one of the most common causes of neonatal respiratory failure and neonatal death, however, its clinical characteristics are very different from premature RDS, and these characteristics have not been well documented as yet. This study was to investigate the pathogenesis, clinical characteristics and management strategies of RDS in full-term neonates, with the aim of developing a working protocol for improving the outcome in full-term neonates with RDS. Methods A total of 125 full-term infants with RDS were enrolled in this study. Their clinical and laboratory data were collected for analyzing the characteristics of full-term neonatal RDS. Results （1） The 125 cases included 94 male and 31 female infants, vaginal delivery occurred in 80 cases and cesarean section in 45 cases. （2） The onset time of RDS was （3.11±3.59） hours after birth. （3）The possible reasons included severe perinatal infections in 63 patients, elective cesarean section in 34 cases, severe birth asphyxia in 12 patients, meconium aspiration syndrome in 9 patients, pulmonary hemorrhage in 4 patients and maternal diabetes in 3 patients. （4） Complications included multiple organ system failure （MOSF） in 49 patients, persistent pulmonary hypertension of newborn （PPHN） in 25 patients, acute renal failure in 18 patients, severe hyperkalemia in 25 patients, severe metabolic acidosis in 6 cases, severe myocardial injury in 9 cases, pulmonary hemorrhage in 3 cases, disseminated intravascular coagulation in 14 patients and shock in 12 patients.（5） Four patients died, the mortality was therefore 3.2% with the main cause of septicemia complicating of MOSF, but their prognosis was improved while comprehensive treatment measures including early mechanical ventilation and broad spectrum antibiotics were taken into account. Conclusions RDS is not an uncommon disease in full-term infants and is associated with a higher mortality, its clinical characteristics are very different from premature RDS, and its onset is earlier and is more likely to develop into PPHN and/or MOSE The main cause of death is severe infection complicating of MOSF and most patients require prolonged mechanical ventilation. Comprehensive management strategies will help to improve patient＇s prognosis.     

低位大骨瓣开颅术治疗额颞顶部广泛对冲伤的临床研究

目的 探讨低位大骨瓣开颅术治疗额颞顶部广泛对冲伤的临床应用价值.方法 采用低位大骨瓣开颅术对46例额颞顶部广泛对冲伤患者进行手术治疗,术后3~6个月采用格拉斯哥预后分级标准进行临床疗效的评定,并对并发症进行分析.结果 46例中预后良好22例(47.83%),中度残疾6例(13.04%),重度残疾4例(8.7%),死亡14例(30.43%),术后主要并发症为迟发性颅内血肿、脑穿通畸形、脑积水、颅骨缺损综合征等.结论 低位大骨瓣开颅术是治疗额颞顶广泛对冲伤(尤其是单侧)的良好手术方式. Abstract： Objective To evaluate the value of low large trauma craniotomy in frontotemporal and parietal contrecoup craniocerebral injury. Methods Forty-six patients with frontotemporal and parietal contrecoup craniocerebral injury were treated by low large trauma craniotomy. Based on GCS, the clinical curative effect and complications of these patients during 3 to 6 months after operation were evaluated. Results Twenty-two cases (47.83%)recovered well, 6 cases(13.04%)suffered from moderate disability, 4 cases(8.7%) remained severe disability, and 14 cases (30.43%) died. The common comlications after operation were delayed intracranial hematoma, cerebral penetrating malformation, hydrocephalus, defect of skull syndrome and so on. Conclusions Low large trauma craniotomy is a good therapeutic method for frontotemporal and parietal contrecoup craniocerebral injury.     

Relationship between serum S-100 protein level and ischemic damage degree in patients with acute cerebral infarction

Objective： To investigate the time course of serum S-100 concentrations of patients with acute cerebral infarction,and their relation with the clinical data and the prognosis. Methods： Serum S-100 levels were serially determined in 36 patients with acute cerebral infarction within 12 h, at 24 h and day 2, 3, 4, 5, 7 and 10 after acute cerebral infarction and in 20 age- and sex-matched control subjects. An S-100 content assay was performed using a two-site radioimmunoassay technique. The clinical status was assessed using NIH Stroke Scale. The functional deficit at 4 weeks after acute cerebral infarction was scored using the modified Rankin scale. A cranial computed tomography was performed initially. Results： Elevated concentrations of S-100 （〉0.2μg/L） were observed in 29 of 36 patients with acute cerebral infarction,but none of the control subjects. The S-100 peak levels were at day 2 and 3 after acute cerebral infarction and were significantly high in those patients with severe neurological deficit at admission, with extensive infarction or with space-occupying effect of ischemic edema as compared with the rest of the populations. Conclusion： Serum S-100 level assay can be used as a peripheral marker of ischemic brain damage, and may be helpful for evaluation of therapeutic effects in acute ischemic stroke.     

Rhubarb extracts in treating complications of severe cerebral injury

Objective To investigate the therapeutic effects of the Chinese medicinal herb, Rhubarb, on severe brain injury.Methods Rhubarb extracts in ethyl alcohol and water were used to treat 20 patients with severe cerebral injury complicated by hyperthermia, renal failure, hemorrhage in the upper digestive tract, and increased intracranial pressure.Vital signs, variations of Glasgow coma scale (GCS) and intracranial pressure (ICP) of the patients were observed.The degree of hemorrhage in the digestive tract and the change in creatinine value were also observed.Other 20 patients served as controls.Results The result of the treatment group was more marked than that of the control group.Three days after administration of the rhubarb extract, the body temperature decreased by 1.1℃, ICP by 0.4kPa (1mmHg=0.1333kPa) on average, and the incidence of hemorrhage in the digestive tract by 30%.The volume of hemorrhage of the digestive tract decreased by 700±250ml, and the time for turning occult blood to negative by 10%.Conclusion The Chinese medical herb, rhubarb, has multiple therapeutic effects on severe brain injury.     

Value of percutanous catheter fragmentation in the management of massive pulmonary embolism

Background Acute massive pulmonary embolism （PE） is a clinical emergency requiring rapid and supportive measures. Percutanous mechanical thrombectomy is considered as a treatment option. The purpose of this study was to evaluate the clinical efficacy and safety of peructaneous mechanical catheter fragmentation in the management of acute massive PE. Methods From January 2003 to June 2007, 28 patients （20 men, 8 women; mean age 64 years） with acute massive PE initially diagnosed by computed tomography and confirmed by pulmonary angiography were treated with inferior vena caval filter placement and percutaneous catheter fragmentation. Twenty-six patients received thrombolytic agents after embolus fragmentation. Results Technical success was achieved in all patients. The improvement of clinical status and restoration of blood flow in the main branches of the pulmonary artery were seen in 27 patients. Only one case did not benefit from the percutaneous therapy and died from the failure of the surgery. Oxygen saturation increased from （86.2±4.5）% to （96.1±3.2）% （P 〈0.001） after the interventional procedure. The post-procedure mean pulmonary artery pressure decreased from （34.2±4.8） mmHg to （25.2±5.1） mmHg （P 〈0.001）. During clinical follow-up （range, 1-5 years）, no patients had recurrence of PE. Conclusion Percutaneous catheter fragmentation combined with thrombolysis is an effective and safe therapy in the clinical management of acute massive PE.     

颅脑损伤术中急性脑膨出的原因及治疗对策

目的探讨颅脑损伤术中脑膨出的原因及治疗对策。方法 39例颅脑损伤术中发生脑膨出患者的临床资料进行回顾性总结。结果本组病人术中发生急性脑膨出的原因包括广泛严重性脑挫裂伤.急性脑肿胀（20例）,迟发性颅内血肿（15例）,晚期脑疝.血肿压迫时间过长（2例）,创伤性休克和术中低血压导致脑组织缺血.缺氧（2例）。出院时按GOS评定预后：良好2例,中残3例,重残5例,植物生存3例,死亡26例。结论急性脑肿胀.迟发性颅内血肿是术中急性脑膨出的主要原因,明确颅脑损伤术中发生急性脑膨出的原因,尽早采取相应措施,以取得较好疗效,降低患者死亡率。     

重型颅脑损伤术中急性脑膨出临床分析

目的:探讨重型颅脑损伤患者术中急性脑膨出的主要原因、临床表现和救治措施。方法:对33例重型颅脑损伤开颅术中出现急性脑膨出的临床资料进行回顾性分析。结果:所有患者均行急诊开颅手术治疗。术后恢复良好9例,中残2例,重残2例,植物生存9例,死亡11例。结论:迟发性颅内血肿和急性弥漫性脑肿胀是导致脑膨出的主要原因,早期诊断,针对不同的原因及时采取相应的措施处理是提高救治成功率的关键。     

颅脑损伤术中急性脑膨出的原因及防治

目的探讨颅脑损伤术中急性脑膨出的原因、机制及防治方法。方法回顾性分析了我院近3年收治的56例颅脑损伤术中急性脑膨出病例。结果本组56例病员中,术中出现迟发血肿39例,弥漫性脑肿胀10例,大面积脑梗死4例,麻醉原因2例,输液过多1例,按GOS预后评分良好者23例,中残17例,重残5例,植物样生成3例,死亡8例。结论颅脑损伤术中出现急性脑膨出,针对病因采取积极适当的措施可以提高治疗效果,改善预后。     

重度颅脑损伤中急性脑膨出原因与治疗分析

目的：探讨重度颅脑损伤中急性脑膨出原因与治疗。方法该研究随机抽取该院2010年5月—2015年12月期间收治的80例重度颅脑损伤急性脑膨出患者,分析其脑膨出具体原因类型以及恢复情况。结果急性脑膨出原因中,迟发性颅内血肿为55.00%,大脑半球急性脑肿胀为26.25%,术前休克与呼吸障碍引发脑组织缺氧为13.75%,广泛性脑挫裂伤为5%;在恢复情况上,恢复良好者16.25%,中度残疾者8.75%,重度残疾者10.00%,植物生存者5.00%,死亡者61.25%。结论重度颅脑损伤中急性脑膨出原因多样,要做好针对性处理才能有效的保证患者生存质量。     

38例重型颅脑损伤术中急性脑膨出救治体会

目的探讨重型颅脑损伤术中急性脑膨出的原因及治疗方法。方法对38例重型颅脑损伤术中急性脑膨出患者的临床资料、治疗及结果进行回顾性分析。结果 38例重型颅脑损伤术中急性脑膨出患者术后复查显示迟发性颅内血肿31例,其中硬膜外血肿20例、硬膜下血肿6例、脑内血肿5例;单纯急性脑肿胀7例。其中进行2次手术为26例。38例患者中共死亡21例。结论术中应认真分析急性脑膨出的病因并针对不同的病因采取针对性的治疗,可以有效降低病死率及致残率。     

颅脑损伤术中急性脑膨出救治分析

目的 探讨颅脑损伤开颅术中急性脑膨出的原因及防治措施.方法 回顾分析86例在开颅手术中出现急性脑膨出的重型颅脑损伤患者的临床资料.结果 迟发性颅内血肿42例,急性脑肿胀38例,大面积脑梗塞及其他原因6例.伤后半年按GOS评估,恢复良好27例,中残15例,重残9例,植物生存7例,死亡28例.结论 术前应综合分析判断发生术中脑膨出的可能性,对迟发性颅内血肿早期诊断,及早清除血肿减压;对急性脑肿胀或大面积脑梗塞引起的脑膨出及早去除病因,迅速减压关颅.     

重型颅脑损伤术中急性脑膨出的原因及治疗

目的：探讨重型颅脑损伤术中急性脑膨出的形成原因及防治措施。方法分析45例重型颅脑损伤去骨瓣减压术中出现急性脑膨出的患者的临床资料进行回顾性分析。结果本组经术后随防半年按 GOS 标准评定预后：恢复良好9例（20%）,中度残疾16例（35.5%）,重度残疾12例（26.7%）,死亡8例（17.8%）。结论重型颅脑损伤术中出现急性脑膨出的原因有多种,针对不同原因采取有效的综合防治措施有助于改善患者预后及降低患者的死亡率。     

重型颅脑损伤患者术中急性脑膨出的临床分析

目的：对重型颅脑损伤患者术中急性脑膨出的临床分型与治疗进行探讨。方法该研究采取回顾性分析,随机选取2013年2月—2014年1月收治的40例重型颅脑损伤患者的脑膨出症状予以分型分析并采取治疗,对比以上急性颅脑损伤患者的GOS评分情况。结果其中对侧血肿型重型颅脑损伤预后较好,其死亡率仅为10.00%,弥漫性脑肿胀型预后较差,其死亡率高达80.00%,明显较对侧血肿型重型颅脑损伤高,该2组对比差异有统计学意义。结论对于重型颅脑损伤患者予以分型辩证,对患者的预后情况及临床特点具有一定的临床意义。     

重型颅脑损伤开颅术中急性脑膨出原因及防治

目的探讨重型颅脑损伤开颅术中急性脑膨出原因及防治。方法对术中出现急性脑膨出的46例病人进行回顾性分析。结果导致脑膨出的主要原因有迟发性颅内血肿、急性弥漫性脑肿胀、低血压、低血氧及较大回流静脉的损伤。结论术中出现急性脑膨出的病因是多方面的，针对不同的病因采取相应的措施，可以减轻脑组织的损害，降低病死率。     

重型颅脑创伤术中脑膨出原因及防治措施

目的：探讨重型颅脑创伤术中,急性脑膨出的原因及应对方法。方法：收集2000～2008年本院神经外科住院的重型颅脑创伤水中出现急性脑膨出的患者29例,分析其发生原因、疗效、预防方法。结果：29例患者中,死亡15例（15／29,51．72％）,其中,弥漫性脑肿胀10例,死亡6例;迟发性颅内血肿8例,死亡2例,术后6个月GOS评分良好3例（37．5％）,中残2例（25％）;其他原因11例,死亡7例。结论：弥漫性脑肿胀和迟发性颅内血肿是术中急性脑膨出的最主要原因（18／29,62．06％）,根据不同病因采取积极应对措施有利于提高临床疗效。